What are safe eczema treatments for a 19-year-old girl?

Question

Hello doctor,

My 19-year-old daughter has been dealing with atopic dermatitis since childhood, but it has significantly worsened since she started college last year. She uses Triamcinolone 0.1 percent cream and takes antihistamines, but her eczema continues to flare up, especially during exam periods. The most affected areas are her face, neck, and hands, which are impacting her confidence in social situations and dating.

Additionally, her menstrual cycles have become very irregular. Sometimes, she goes two to three months without a period. Her dermatologist mentioned that stress could be a trigger for her flares, but we are wondering if hormonal changes might also be contributing.

She often scratches at night, which disrupts her sleep and is now affecting her academic performance. We have tried several lifestyle changes, switching laundry detergents, cutting out dairy, and using hypoallergenic bedding, but nothing has brought lasting relief.

She also has secondary skin infections due to scratching. Just last month, she was treated with antibiotics for cellulitis on her arm.

She is now considering starting birth control pills, but we are concerned about whether they might improve or worsen her eczema. Are there effective treatment options for someone her age that can help manage her eczema without negatively affecting her hormones? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Birth control pills (OCPs or oral contraceptive pills) and eczema (a skin condition that causes redness, itching, dryness, and inflammation):

The relationship is complex and varies by individual. There is no universal answer.

Potential benefits: For some, hormonal fluctuations, especially the drop in estrogen before menstruation, can trigger eczema flares. In such cases, combined oral contraceptives (containing both estrogen and Progestin) may help stabilize hormone levels and reduce flare-ups. Estrogen can have immune-modulating effects that benefit the skin.

Potential risks: Certain progestins have androgenic properties (similar to testosterone), which may worsen eczema or acne in sensitive individuals. To reduce this risk, combined pills with low-androgenic progestins (such as Desogestrel, Norgestimate, or Drospirenone) are typically preferred for those with skin concerns.

Progestin-only pills (POPs or mini-pills): These can cause irregular bleeding and may be more likely to aggravate eczema, particularly due to the lack of estrogen and the possible androgenic effects of some Progestins. They are generally not the first choice for managing skin issues.

Next steps:

Dermatologist follow-up:

Address poor eczema control despite current treatment.
Consider safer alternatives for face and neck (e.g., Tacrolimus or Pimecrolimus).
Review infection prevention strategies, such as bleach baths.
Discuss escalation to advanced therapies like phototherapy, Dupilumab, or JAK inhibitors. Dupilumab is increasingly favored for systemic treatment due to its safety and efficacy.
Discuss the impact of hormonal contraception on eczema.

Gynecologist consultation:

Evaluate causes of irregular periods, including ruling out PCOS or polycystic ovary syndrome is a hormonal disorder causing irregular periods, excess androgens, and cysts in the ovaries.
Review birth control options, with a focus on low-androgenic Progestins, if a combined pill is considered, especially in the context of eczema.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.